Traumatic Shock. Xi. Intestinal Absorption in Hemorrhagic Shock 1

Abstract

The clinical picture of traumatic shock includes obvious disturbance of the gastro-intestinal tract. Nausea and occasional vomiting occur, particularly if fluid or food is taken. Since alimentation and peroral drug therapy apply to the patient in shock as in other illnesses, it is desirable to have some quantitative measure of the degree to which gastro-intestinal absorptive capacity is altered. Experiments in which the absorptive capacity of the small intestine in hemorrhagic shock was measured are herewith reported. The data comprise measurements of the disappearance rates of water, physiological saline solution, and 5 per cent glucose solution from loops of jejunum. the drained fluid and the total volume noted. In the latter 2 instances, aliquots were measured for sodium chloride (1) or glucose (2), respectively.In all dogs, blood pressure was determined continuously by a mercury manometer and a cannula containing heparin in the left femoral artery. Venous oxygen was determined on mixed venous blood drawn from the right heart via a cannula inserted through the jugular vein.The normal findings obtained, the dogs were then bled rapidly to a systolic blood pressure level of 50 mm. Hg and maintained at approximately this level for several hours, after which (in 17 of 21 experiments), most or all of the shed heparinized blood was returned by vein to the circulation.During the hypotensive period and after the transfusion, absorption capacity determinations were repeated for each loop.Control observations were made on dogs prepared as described, except that only local anesthesia was used and hemorrhagic shock was not produced. Absorption studies were made for a period of 3 to 4 hours, the average duration of the shock experiments. RESULTSControl observations. The absorptive capacity of the loops for all 3 solutions in unshocked dogs during a period of some 4 hours after preparing the loops may vary considerably from one test to the next, but the range of variation is such that a moderate but not a sharp decline in absorptive capacity occurs as a function of time (Table I). As will be seen below, such variations are considerably less than those observed in dogs in shock.Absorption of glucose. In morphinized laboratory dogs, glucose absorption from a jejunal loop varied widely. In general, the percentage of absorption in these animals, before shock was induced, was at a low level to begin with. This is possibly due to the fact that most of these dogs had been etherized for preparation of the loops, while the control preparations were made under local anesthesia. Nevertheless, a glance at the shift in absorptive capacity once shock is induced makes the conclusion obvious that absorptive ca-445

The Essential Role of the Intestinal Microbiota in Facilitating Acute Inflammatory Responses

“…This may occur, for example, after hypovolemic shock and facilitate the translocation of bacteria and/or bacterial products, such as LPS, with ensuing activation of macrophages and infection of the organism (22,23). Whereas some investigators have found elevated concentrations of LPS in systemic or portal system blood following reperfusion of an ischemic vascular bed (14,17,24,25), others, including the present study, have not been able to detect either LPS or significant levels of circulating bacteria (26).…”

Blood flow distribution, villous tissue osmolality and fluid and electrolyte transport in the cat small intestine during regional hypotension

“…Small intestinal fluid and electrolyte transport during hemorrhagic hypotension has been studied by several authors using different experimental animals and methods with varying results. Some investigators have found a increase in fluid and electrolyte absorption after hemorrhage, at least during the early phase (Mailman & Ingraham 1971, Fromm 1973, Mariscotti et al 1977, whereas others, mainly using dogs, have observed a decrease in absorption or a pronounced secretion (Goldberg & Fine 1945, Porciuncula & Crowell 1963, Cook et al 1971.…”

The balance between the production of tumor necrosis factor-alpha and interleukin-10 determines tissue injury and lethality during intestinal ischemia and reperfusion

“…This may occur, for example, after hypovolemic shock and facilitate the translocation of bacteria and/or bacterial products, such as LPS, with ensuing activation of macrophages and infection of the organism (Goldberg & Fine 1945, Grotz et al 1995. Whereas some investigators have found elevated concentrations of LPS in systemic or portal system blood following reperfusion of an ischemic vascular bed (Turnage et al 1994, Swank et al 1994, Cicalese et al 1997, 1999 others, including our group, have not been able to detect either LPS or significant levels of circulating bacteria (Nezu et al 2002, Souza et al 2004c).…”